Susan Dunlop

Sarah Bell ‘The Successful Nurse Leader – the ultimate transition guide from nurse to manager to leader’ (podcast transcript)

Susan Dunlop: Welcome to episode 55 of Coffee and Contemplation with Susan.

Hello, I’m Susan Dunlop. I hope your day has been fruitful so far. Today’s guest is Sarah Bell, who I will be welcoming in, in just a moment. Sarah is a peer 3 Vital Questions certified trainer, and I reached out to her on referral from another trainer who said to me that Sarah was the leader in coaching nurses. I reached out in my research around my vision for where I’m taking my coaching combined with training here in Australia using the 3VQ model.

I was acutely aware of the issues I’d witnessed and played a part in resolving by way of being what one good DON (Director of Nursing) friend called a “much-needed compression bandage stemming the hemorrhage. That is, the never-ending staffing issues that play out year on year across the acute and aged care sector of nursing here in Australia. She did say compression bandage after I had said golden bandaid, very much a needed service, being a nursing agency.

Sarah and I’ve had many zoom chats on our mutual understanding that the body of work we’re both certified in is life-changing, it fits with any leadership training programs, and it has been embraced large scale to date in the USA. So where can I take it here?

Both of us, we found out this week, are high percentage ideators. So we’ve found it very easy to shoot the possibilities breeze, at odd hours!

Sarah has been an ICF certified coach working with nurse managers, nurse leaders, and other healthcare professionals in the US, people who are seeking leadership growth and development and she’s done that for 20 years. She’s also got 30 years experience as a registered nurse, that began in the United Kingdom, continued in the United States. Sarah said on the back cover of her book, we’re about to discuss today, that she struggled with the idea that healthcare is a business. She observed and personally experienced the pressure nurse leaders face to achieve both clinical and business goals.

Welcome, Sarah, I’m looking forward to our conversation.

Sarah Bell: Hi Susan, thanks so much for inviting me to join you. I’m looking forward to this.

Susan Dunlop: It’s well-timed too, because there are a few really good milestones coming up this week for you and they correlate with it being International Nurses’ Week that starts here today in Australia, tomorrow for you.

Sarah Bell: Yeah, I do have some milestones coming up and I can talk about those and the challenges that I’ve had to overcome to make this happen for me.

Susan Dunlop: Beautiful. So what we’ll do, we talked about the direction, and given your book will be open for pre-orders later in the week, that will be the no brainer – that we’re going to celebrate that milestone in terms of you have written the book. I’ll just share the title, or would you like to share the title given it’s your book?

Sarah Bell: Okay, why not? It’s called The Successful Nurse Leader – the ultimate transition guide from nurse to manager to leader. It’s for new managers or nurses who aspire to become a manager.

Susan Dunlop: Sarah, do you recall the ideas moment that seeded the book to come into fruition?

Sarah Bell: Yes, I recall it well, and actually it is connected to the 3VQ material. Prior to what I’m doing now, I was a corporate coach for a healthcare company and spent a lot of time coaching nurse managers. And what I began to realize was when it came to the Dreaded Drama Triangle, the things they were complaining about were actually part of their job as a nurse manager and it’s connected to the struggle that I had in accepting the fact that healthcare these days is a business. And, you know, as a nurse, I just wanted to focus on patient care and so did my clients. When I realized I was trying to coach them around something that they hadn’t yet understood was their responsibility I felt that I needed a book or something as a baseline to give them the understanding of what a nurse leader does so that then I could coach them going forward from there.

Susan Dunlop: Okay. So you’ve been coaching in this work for 20 years.

Sarah Bell: I was an educator and then I transitioned to coaching in 2013.

Susan Dunlop: Can you tell me a little bit of the journey of the book? You know, the idea, research, any aha moments, any stumbles and falls and need for a mantra to get you through again. I know book journeys can be interesting.

Sarah Bell: Uh, lots of stumbles, lots of falls. I mean, a lot of time to actually be able to sit down and write. I did a lot of talking about it, which put me in the position where I’ve talked so much, now I really have to do it. And then sitting down and writing it. In the end, what I did, I was trying to be structured and organized and professional. And then I realized, you know what? I am just going to write it like I’m talking and then fix it afterwards. And it’s really, it’s not research-based particularly. I mean, there are some things in there that connect it to other people’s work. So it’s not just my thoughts, but I wanted it to be a light and easy read. I didn’t want it to, you know, to be a hard book to read. I wanted it to be usable. You can pick it up and run with it.

Susan Dunlop: Yeah. I got that! Obviously you shared the PDF with me to have a sneak peek and I could feel you’ve got your tone in there it’s a really lovely voice that you’re using in the book. And you’re cheeky and, you’re just speaking in the common language that people just need to hear. That’s one really key thing I spotted very easily.

Sarah Bell: There’s not a lot of big words. I’m not a big word kind of person.

Susan Dunlop: No, that’s great. And any types of challenges that have come up with it otherwise because you’re up to pre-launch now. What’s happening?

Sarah Bell: Yes. I’m up to prelaunch. I mean, honestly, if I’m honest, the whole thing has been a challenge. It’s an experience that I’ve never gone through before. So there’s been some ups and downs, I think the most valuable part, you mentioned about research and this was kind of a challenge for me. I’m more of an introverted kind of person. I had to put myself out there and ask nurses out in the field, leaders, if I could interview them to find out their experiences, to make sure that I was going to write a book that was needed. That was a lot of work, but it was so valuable in the end. That was one of the biggest challenges. Really just putting myself out there for me is the biggest challenge.

Susan Dunlop: So it’s perfectly named and perfectly timed to support and celebrate nurses transitioning from expert clinician to manager to successful leader. In preparing for our episode today, you and I both looked up what the theme was for the year, because I’ve been out of that loop for a few years and the International Council of Nurses set of theme each year for nurses day. Again, how about you read that out because this is your baby?

Sarah Bell: The theme? Nurses – a voice to lead, invest in nursing and respect rights to secure global health.

Susan Dunlop: I read in a further paragraph, it’s focusing on the need to protect, support and invest in the nursing profession to strengthen the health systems around the world. Which to me feels like your book comes in at the right time to maybe do that: protect, support, and invest in the nursing profession.

Sarah Bell: And you know, one of the things from doing the book interviews and meeting people like you, Susan, and other nurses, this is a global thing. It’s not just a US challenge that we’re facing right now.

I think nurses should be leading nursing. I don’t think business leaders should be leading nursing, quite frankly. However, if we really want a seat at the table and we really want to be the leader of the profession, we first have to learn what a leader is and what a leader does. Otherwise we can come across, maybe not as empowering as we’d hoped for.

I understand there’s a lot of anger in nursing right now, especially after going through COVID. However, being angry or just feeling beaten down, quite honestly, I speak to nurses and they’re just exhausted and they feel beaten down. If we come from that perspective, we’re really not going to get the recognition that we need to get our seat at the table and take the lead for nursing.

Healthcare is a business, we need to collaborate with the business leaders and we need to be the ones guiding them. At the moment, I don’t feel like that is what is happening. I think the business leaders are doing what they do the best. They know the processes for running a business and they understand you need a process, you need metrics and all of that, but a lot of them they are not health care professionals and they’re definitely not nurses. We need to be at the table, but we need to have a strong voice at the table.

Susan Dunlop: In your history of nursing, when did you see a particular time of change that has led us to where we are now? Like, was it nurse-led when you first started in the profession and it has changed to a business model or what?

Sarah Bell: Well for me. Yeah. However, I started out in the National Health Service in the UK. The hospitals in the UK back in the day, it’s changed now, we were really much led by healthcare professionals, but even the National Health Service started to shift to a more business-like model because the more treatments and things that were available, the more costly it became, there had to be a balance between what would be provided. So that shifted us into a business model. Then I left the NHS and went to a private company. And that’s really when I was like a fish out of water for the longest time, I couldn’t understand what was going on.

I think that led to disempowerment for nurses. We need nurses in management.

There needs to be training and education for nurses if you’re going to shift up in the management position. Then we also need nurses who are happy to stay clinical bedside and be a leader from that perspective and hold the same level of value as a nurse that steps into the operational side of healthcare. Because I think the ones that stay bedside really don’t get recognized for the value they bring in to the field, that’s very sad.

Susan Dunlop: I agree. So what would you say would be the three key elements in your book that will relate to the theme for international nurses in 2022?

Sarah Bell: The beginning of the book, I talk about what leadership is, and I think this is key. I think we need to understand that there are processes and that leadership is a thing on its own. And I talk about it as a new specialty.

So consider yourself when you’re stepping into a management leadership position, you’ve now entered a new specialty and you have new things to learn. It’s not just about telling people what to do and hoping they’ll do it.

We also need to learn to engage with all of our resources. And so that means engaging with maybe senior executives, but also leaders in things like quality and finance, really building those relationships. Not only are they going to be supportive of us when we build those relationships with them, it helps us to have that presence at the leadership table.

So that is extremely important, I believe.

There’s another aspect in there which is kind of interesting, I think, for a new manager to consider, but it’s succession planning. So it’s further on in the book. In my experience, we’re not very good at building up leaders beneath us, and that causes all kinds of day-to-day issues.

However, if we want to become a forceful profession, the more leaders we grow underneath us, the more powerful we become as a group.

So those are probably the three main things that I think are key.

Susan Dunlop: You’ve nailed it really. How about in terms of challenges you’ve witnessed for emerging nurse leaders that you coach, and we’re both certified trainers in The Empowerment Dynamic and the 3 Vital Questions, and that’s all about transforming drama into empowerment or challenges into results.

How do you see the Dreaded Drama Triangle play out and how The Empowerment Dynamic has better served the nursing profession?

Dreaded Drama Triangle

Sarah Bell: A lot of nurses in my experience get promoted because they’re these outstanding individual contributors. They know how to take care of the patients and they do exceptionally well and they get recognized for that by the senior management and then they get promoted.

Knowing how to be a great nurse is great, it doesn’t make you a great leader because, as I said leadership is a whole new skill.

And so what I see happen is this amazing, outstanding nurse steps into their management position and starts telling everybody this is what you need to do.

Well people, first of all, typically don’t like being told, well, maybe not everyone, I don’t like being told what to do, so I’m assuming that most people don’t like being told what to do. That takes us directly into the drama triangle, because this poor nurse who’s been recognized as being outstanding is suddenly struggling because she’s telling or he is telling people what to do and the drama unfolds. We have the nurse manager feeling like a victim because people are not responding the way that the manager had hoped. We have the employees responding like victims because they’re just not being recognized and acknowledged for their own value that they bring to the team.

So they’re seeing the nurse manager as the persecutor, they’re the victims and the rescuer?

I think we have a tendency as nurses to slip into the rescuer role because of the profession we’re in.

We’re very used to taking care of people, and, you know, it’s the patients that we start off taking care of, but you have to recognize that staff are not patients. They are valuable, they’re knowledgeable, they’re experienced, they’re competent and they’re capable.

And I see nurse managers over and over again: I don’t want to overwhelm my staff. I don’t think that they’re going to do it well, I’d be better doing it myself. And before, you know, it, they’re just overwhelmed and overloaded. And then they’re slipping into the victim mindset that the role is too hard. And so a lot of what I do is coaching them around that and into The Empowerment Dynamic and the Creator, the Coach, and the Challenger roles or mindset.

The Empowerment Dynamic

Susan Dunlop: Things that came up, while you’re saying that, we know that nurses have been loaded with more and more paperwork, more and more to be done in say the eight-hour shift. Is time management part of what you coach, because I could see that you will rescue someone because you can’t be bothered with letting them just learn their way through it or trusting that it’s going to get done. So you do slip into that rescuer space, I imagine.

Sarah Bell: Yep! Chapter 2 of my book, winning the battle against time management.

Again, it’s looking at things from a different perspective and you start with yourself and I understand, yes, oh my gosh, there’s always stuff coming down the pipe in a healthcare organization. In the moment it does feel quicker and easier if I do it myself, and then your list gets longer and longer and longer and longer.

And then it’s hard to find the time to delegate and teach other people. So it is a challenge. We have to be willing to let stuff go sometimes. And we have to be willing to raise our hand and say, if you want me to do this, I will. But if I’m doing this, these two things are not going to get done. And this is where we need to have our voice at the table, because if we’re not speaking up, nobody in the ivory tower is realizing what is happening down below because we’re scrambling around trying to make everything okay, trying to get everything done and trying to be that good nurse that we’ve always been recognized as, and sometimes we need to shift and lead for our team as well.

Susan Dunlop: And that’s a shift to The Empowerment Dynamic model. How have you found that being embraced in the nursing industry, in terms of the Creator, Challenger and Coach roles?

Sarah Bell: Very, very well. It’s very well received, I think partly because it provides a model. So it takes us out of that reactionary, in the moment, oh my God, what do I do?

It gives you a model to anchor your decisions and your choices to, to take a step back, hit that pause button and go, okay. What do I want? What matters most in the moment and shift your mindset into, maybe somebody needs to be coached. Somebody may need to be challenged or maybe I need to sit down with somebody and co-create with them. It gives a nurse that direction to go in, rather than just trying to figure out in the moment and putting a bandaid on right there and then in the moment and moving on.

Susan Dunlop: I look back to my old days of being a nursing agency, that feeling, as I felt being a bandaid, or at least a golden bandaid. It was a very expensive way for someone to keep on trying to rectify the problem cycle, round and round and round and round. It wasn’t looking at what’s the root cause? What’s the real problem? What should we be focusing on that are the bigger picture issues and to me, there was a really big picture that could be expanded on, but I won’t take you into that right now…

Sarah Bell: Yeah, you kind of made me think of something as well. When we’re working long, long hours and doing all of this work and everything, we’re giving the message that everything is doable.

Until we call time out and say, No! and we step into The Empowerment Dynamic, and, maybe we need to challenge, be the Challenger for the senior leadership team, because if they don’t know why we’re struggling and that they’re a part of that struggle; if we give them the impression that everything’s manageable and doable, and we’re just dying on our feet, they don’t know that. They’re not going to do anything different.

Susan Dunlop: No! I’m interested in the CEO side of things, you’re into the nurse management side, and I’m looking at that CEO space and from what I see, a lot of the use of the model by other trainers has been it’s started with the CEO realising they need to do the work first. They need to understand the underneath, I love that phrase, one CEO said. It was his seeing the change from drama to empowerment came from understanding the underneath.

And I don’t think many human beings have had time to do that at a great depth. So that’s exciting for me to be able to think, well, if I could get to the CEOs and you’ve got the nurse leaders, if we can get them to meet in the middle and have this new common language, how transformational would that be!

Sarah Bell: The common language is going to be so amazing. Yes, it will be, a common language and a common model to all work around. And the other aspect of that, I think Susan is that each and every one of us has to take responsibility for our own underneathness. It’s very easy to point the finger and blame. And somebody once said to me, you’ve probably heard this, you’re pointing the finger at somebody, how many fingers are pointing back at you? Right.

We have to really own our underneathness before we can expect somebody else to change.

Susan Dunlop: That creator comment I’ve heard before too, I think it was Donna Zajonc, at The Center for The Empowerment Dynamic, who said: Creators ask for help. Victims try to do it by themselves.

Sarah Bell: That’s interesting, right? Because victim’s try to do it themselves. Nurses have a tendency to do it themselves. They are strong. But you don’t have to bear the weight of the world on your shoulders. You don’t have to do it by yourself. Here’s one of my favorite sayings, just because you can doesn’t mean you should.

It’s not good for you. And it’s disempowering for everyone around you. When you’re doing everything, the message you’re giving your team is yeah, you’re not good enough. I’ll do it. You’re not strong enough, whatever it is.

Why are you not developing your team and trusting them?

Susan Dunlop: It’s disempowering in the end, isn’t it? Okay. Well, that’s interesting. The other thing you just mentioned there about the reactionary side of things, we talked about the other week, is that nurses are mostly trained to be reactionary because they’re checking vital signs and the like. Can we talk a little bit about that in relation to the space you’re working in with nurses to shift out of that reactionary space, as much as they can because obviously they need to be both!

Sarah Bell: Yeah. It’s another case of your greatest strength can become your greatest weakness. Right?

There is no doubt nurses are strong individuals. Oh my goodness. Like there is no doubt about that. One of our strengths is we can in a heartbeat, jump to action. Maybe there’s a cardiac arrest. Maybe somebody is bleeding, whatever it is, right? In the moment we can stop what we’re doing and we can leap in and we’re trained that way and that is great as a nurse. It’s not so great as a leader.

So this muscle that we’ve all developed, the going around and taking vital signs, we’re jumping in and we’re saving people’s lives and whatever we’re doing.

Our staff don’t need us to jump in and rescue and save their lives. Our staff need us to take a step back and make space for people, make it safe for people to learn, make it safe for people to make mistakes and celebrate that and encourage people along the way to grow and learn so you’re developing a strong team around you.

And so it’s not a case of, oh my gosh, nurses are bad and they’re reactionary. No it’s a great strength until you transition to a leadership position and then you have to develop new skills.

Susan Dunlop: It gives you goosebumps realizing just how incredible they are that, they’re like bang! They’re just tuned in. It just blew me away watching how the nurses got about their day, if they were in the ICU, just totally tuned in. I love it!.

Sarah Bell: I mean, there’s a reason why they’re the most trusted profession yet again, because you can rely on a nurse and you can trust them. Nurses are just not so good at looking after themselves.

Susan Dunlop: Interesting yesterday, I saw on LinkedIn a post and I haven’t got it here to recall the whole thing, but it was the Conscious Leadership Group who I follow, who also very much models The Empowerment Dynamic work, but they put out another perspective on burnout. It was burnout is caused by living with a victim consciousness because we’re waiting to be rescued. We’re going to keep pushing ourselves, hoping someone’s going to notice, or something’s going to change, or someone’s going to tell us we can do it a different way. What do you think about that because burnout is a very big topic at the moment in relation to nursing?

Sarah Bell: I do think maybe there’s a lot of validity to what you just shared. I think we do, we do create some of the burnout for ourselves and, you know, then we have the moral distress. And I think because we’re not stepping up and being the leaders of our profession, we’re also contributing to the moral distress when we’re doing things that don’t feel right as a nurse. However, we’re kind of subservient in a way, right aren’t we? Like, if the somebody up here tells us to do something, we don’t know how to come to the table and say No. So all of this is contributing to burnout, moral distress…

Susan Dunlop: and that’s even just a bigger human being side of things, we’ve not all been taught how to communicate confidently either from childhood, so that marries into that as well.

Sarah Bell: Yep, and especially the majority of nurses are still women so that plays into it. Then we have the old doctor-nurse relationship that still is not a level playing field. I think that’s gotten a lot better. And I think there are great doctors out there who truly value nurses, but I don’t think that’s where it needs to be either. And this is why leadership – we need to own our profession.

I mean, how many nurses listening to this have saved a doctor’s you-know-what in the past, because of their knowledge and their ability and their skill. I’m going to tell you, most of them will probably raise their hand and say, yes, they have.

Susan Dunlop: Okay. So in terms of your book, it is about taking steps towards becoming an influential and impactful nurse leader. Is there one first step that you would say is the first step forward, apart from buying your book? Is there another step a nurse could consider as that first baby step towards it?

Sarah Bell: Yeah, truthfully to get on Google and Google leadership styles and just understand. You don’t have to do a lot of reading and you don’t have to go into depth or anything, but just understand the different leadership styles and you’re probably going to want to become skilled in a couple of them. Autocratic leadership gets a bad rap. If you’re in the middle of a cardiac rate, you’re going to be autocratic and you’re going to tell people, get the cart, whatever you need to do. So there’s a place for that. Every day, though, you’ll probably want to be a coaching style leader, a servant leader, understand what those leadership styles are, that would be the first step to just open your mind.

If you haven’t done already, open your mind that leadership is a thing. It’s not just a job. You don’t just step into it and automatically be a leader. You can be a boss, right off the bat. That was my biggest mistake.

Susan Dunlop: Oh, we all make mistakes! If someone wanted to do the coaching with you, and you’ve told me how well that you have seen the Power of TED* and the 3 Vital Questions be embraced by the nursing industry, what do you deliver in your coaching in the US? What are you doing, say, if there’s an organisation who wanted to take you in as the coach of their leadership team, how does that work?

Sarah Bell: I have a couple of different programs. If an organization wants to bring me in, I have a group coaching program. It’s the 3VQ. There’s some bite-size videos. When I say bite-size, literally like a minute or whatever, that you can fit into a busy day and then we get together once a week and we move through the 3VQ materials. Then we move into Rookie to Rockstar, that is my program. That is based on the book. So Rookie to Rockstar, is really bringing the book to life and alongside the 3VQ, I didn’t see any point in reinventing the wheel on that. That is an amazing program, that didn’t need any work, that just needed to be included in my program.

Susan Dunlop: Rookie to Rockstar sounds pretty cool. I haven’t got to that part of the book yet! That’d be good to check out.

We’re coming to the end of our chat. What’s your book launch plan? I know you had a glitch this week. Where can people find the book? How’s that all working? And I will add any links that you share to make it easier for people. So tell me about that.

Sarah Bell: I’ve been in the drama triangle this week. Susan, I’m not gonna lie to you. I’m self-publishing on Amazon and I made a mistake and I canceled all of my pre-orders. So my plan was going to be, you get the book for 99 cents as a pre-order then when it gets launched next week, you will have the book. Well, I canceled it by accident and I went into victim mindset. Anyway, I’ve recovered and so the book is going to be published next week.

There are a couple of things you can do if you’re on Facebook, join Sarah’s Book Launch Team, and I’ll give Susan the link to that (click here). If you request to join, I’ll just click you in. You’re going to get all the scoop on the book and you’re going to get all the scoop on the offers that I’m going to make to compensate for the pre-order being canceled, or if you don’t care and you want to go, the ebook is actually live on Amazon right now for $5.99. That’s US dollars, $5.99. Go ahead buy it if you want to but I would say, wait and get in my book launch team because I’m looking at giving a better offer to get the book going and for the International Nurses Week: (Amazon Link)

Susan Dunlop: Oh, perfect. So now, just as we usually finish up, I always ask two final questions. So do you have a mantra that gets you through hard times?

Sarah Bell: Oh, yeah, I’ve been using it this week and it’s I am creative and resourceful and the possibilities are endless. I have to remind myself when I get stuck, like I did this week and I’m going, oh no, everything’s a disaster. And I’m like, wait a minute you’re creative. You’re resourceful. There’s loads of possibilities, different directions you can go. It helps me immensely.

Susan Dunlop: That’s good, you’re vulnerable, you’re real and you make mistakes. But you know, it’s okay to sit with that for a moment and then step back up again isn’t it?

Sarah Bell: Yes. Don’t quit. Don’t give up.

Susan Dunlop: What is your favorite sing out loud song in the car?

Sarah Bell: Do you want me to sing it? No, you really don’t want me to. It’s a real oldie and it’s Up, up and Away in My Beautiful Balloon (Spotify Link here) and I just love it. It’s a real old song. And so it’s a real nice feel-good song that it really helps me to realize I’m this tiny little ant on planet earth and if I get up in there in my balloon and look down, I mean, don’t take it so seriously because we all do make mistakes and life is for living. I’m just this little ant on planet earth doing my thing.

Susan Dunlop: Living and laughing, yes. I think it’s a good plan. It’s interesting. Your mantra and singing out loud song sort of interweave a bit that you’re talking endless possibilities by being resourceful and creative. And then getting lifted up and away towards your vision so that’s that creator in you. Beautiful.

Thank you, Sarah, for talking nurse leadership with me. It’s an exciting time for you in the launch of your book and it’s been a pleasure getting to know you since I’ve joined the 3VQ community and collaborating with you on some ideas. I wish you the best this week and I’ll keep an eye out on your launch as well. It’s been a pleasure having you!

Sarah Bell: Thank you for having me. It’s been fun.

Susan Dunlop: Listeners, we can only change ourselves and do the work on ourselves, be ourselves and model ways to lead in our desire to change lives, workplaces, be that the healthcare and nursing profession or otherwise.

I’m Susan Dunlop, certified trainer, partnering with the Center for The Empowerment Dynamic. I was once founder and CEO of a small turned large healthcare organisation in the form of RNS Nursing, a nursing agency. I have chosen to bring all I learned into my practice as a certified professional coach and trainer to transform leaders, teams, and company.

Do you know any business owners, leaders, managers, teams, or companies as a whole, who are struggling to deal with say, low staff, morale, workplace drama, gossip, absenteeism, and the like; lack of shared vision or direction, disengaged staff, high staff turnover, wasted time, energy, and focus and lost productivity?

Through my one-to-one coaching, online facilitated 3VQ e-learning programs and workshops, I support business owners and leaders and teams and companies, to greatly improve their employee engagement, transform company culture, work towards a vision that’s shared. It helps a leader to grow in themselves and it grows and empowers their people and it positively impacts all the personal or most important relationships they have that is including with them.

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Bye for now and take care.

Susan Dunlop

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